The most popular osteoporosis drugs may be much more dangerous than we ever imagined

Down the hatch

This has to be one of the strangest instructions for taking a drug I’ve ever seen: “Never take alendronate at bedtime or before you wake up and get out of bed for the day.”

Got that? Don’t take alendronate before you wake up.

That’s just bizarre! But odd as it sounds, you could put your life in serious danger if you don’t carefully follow that and other directions for alendronate, the generic name for Fosamax, the popular bisphosphonate drug that treats osteoporosis.

Here are some other Fosamax instructions:

* It must be taken right after you get out of bed, before you eat
* It must be taken with a full glass of water, followed by more water
* It can’t be taken with any other liquids
* After taking, do not lie down for at least 30 minutes
* After taking, sit upright or stand for at least 30 minutes, then take your first food of the day

When drug instructions are THAT specific and THAT demanding, what you’ve got is a big red flag warning that something potentially very dangerous is going on here.

And it is.

Hard to swallow

If Fosamax and other bisphosphonate drugs (Boniva, Actonel, etc.) aren’t swallowed properly, the esophagus can be irritated. That’s what’s behind all those special instructions.

If the irritation is too frequent or too intense, it can cause esophagitis — inflammation of the esophagus.

According to Fosamax prescribing instructions, esophageal ulcers and esophageal erosions “occasionally with bleeding” may also occur.

So just getting this pill down your gullet is very serious business. But as bad as those side effects are, the long-range potential for damage with esophagitis is MUCH worse.

A few years ago, Danish researchers reviewed more than 11,000 medical records and found that patients with esophagitis were significantly more likely to develop esophageal cancer.

Recognizing the importance of this potential link, a team of UK researchers examined medical records for more than 93,000 subjects. As reported this past September in the British Medical Journal, the UK team found that extended bisphosphonate use (10 or more prescriptions over five years) nearly DOUBLED the risk of esophageal cancer.

This is pretty horrifying when you consider that more than 20 million people have used Fosamax since it was introduced in the 90s. And that’s just one brand of this very popular class of drugs.

I just met a woman in my horseback riding class on Saturday who was just diagnosed with osteoporosis and was looking at her different options. Obviously, I’m going to forward this email to her…and invite you to do the same if you know anyone who might be using or thinking about using a bisphosphonate drug. Most importantly, they should know that once they’ve successfully swallowed their pills, that’s when other serious dangers loom — especially when the drug is taken for several years.

You can click on this link to find out more about risk of bone fractures with bisphosphonate use.

And at this link you’ll find a discussion of MUCH safer ways to improve bone health and reduce fracture risk.

Sources:
“Exposure to Oral Bisphosphonates and Risk of Esophageal Cancer” Journal of the American Medical Association, Vol. 304, No. 6, 8/11/10, jama.ama-assn.org
“Oral bisphosphonates and risk of cancer of oesophagus, stomach, and colorectum: case-control analysis within a UK primary care cohort” British Medical Journal, Vol. 341, No. 4444, 9/2/10, bmj.com